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mardi 7 mai 2013

PEER TO PEER HEALTH PROMOTION AT WORK PLACE : ZHENG HE'S METHOD OF COLLABORATION


Peer to peer health promotion at work place
The humble boss of Bogor


An old Indian story talks about a group of blind men coming across an elephant. Each of the blind men touched a different part of the elephant and gave a description of what he believed an elephant was. The first person touched the elephant’s trunk and claimed the elephant to be a snake. The second person touched the elephant’s leg and declared the elephant to be a tree trunk. Then the last person came forward, touched the elephant’s ear and positively identified the elephant to be a sail. Based on the blind men’s confined level of interaction with the elephant, their observations made sense. However, if they had collaborated and holistically studied the elephant, its true structure would have become apparent. Understanding complex systems such as the human body can also benefit from the same type of closely interactive collaboration. For many years, biologists have been studying specific proteins and molecular pathways individually, describing local interactions and perturbations in detail. Indeed, understanding the individual components is an important first step, but, to truly understand complex biological systems, an integrated approach must be taken

Leroy Hood, M.D., Ph.D.*
President, Institute for Systems Biology, Seattle, WA, USA

Currently it seems that the plethora of advices regarding Health seem to be led by men and men who are like the blind men above. Body is divided into many parts, and the blind men/ women in charge prescribe treatment, which usually involves either a western medicine or a herbal/alternative medicine to "cure" that particular dysfunction of that organ/ disease.

Very little attention is being paid to the prevention of factors that cause disease, but lots of information is available on how to treat a particular problem, of course for a price, once again not the entire person, but their body component measurements: blood pressure,  blood sugar or cholesterol.

It is my strong belief that in the future, medicine/ health counseling/ care would focus on the individual, becoming proactive to prevent diseases rather than blind men/women waiting in their offices to patch up what is failing in the body. 

We would always need doctors and other professionals for acute inflictions on our bodies, unforeseen happenings in our bodies and mind dictated by our genes and bad luck, such as accidents, both man made and natural.
But majority of suffering is of chronic nature, and it is here that prevention is much better than a cure!
Currently, obesity, heart disease, diabetes, high blood pressure and preventable cancers kill more people than any other cause. If you add to that depression, impotence, suicide, drug  tobacco and alcohol abuse, you would readily agree that prevention is the key to a healthy life!

April 29,2013, published in British medical Journal (On Line) (follows)

Men Who Are Obese While Young Can Pay a Price Later
Danish study found overweight males in their 20s had worse health in middle age

-- Men who are obese in their early 20s have a significantly increased risk of dying or of having serious health problems such as diabetes and heart disease by the time they reach age 55, a new long-term study indicates.
Researchers tracked the health of 6,500 Danish men from age 22 until age 55. At the start of the study, 83 percent of the young men had normal weight, 5 percent were underweight, 10 percent were overweight and 1.5 percent were obese.
By the end of the follow-up period, nearly half of the men who were obese at age 22 had been diagnosed with diabetes or high blood pressure, suffered a heart attack, stroke or blood clots in the legs or lungs, or had died.
Compared to those with normal weight, obese young men were eight times more likely to develop diabetes, four times more likely to have a potentially fatal blood clot, and more than twice as likely to develop high blood pressure, have had a heart attack or to have died, according to the study published April 29 in the online journal BMJ Open.
Every unit increase in body mass index (a measure of body fat based on height and weight) was associated with a 5 percent increased risk of heart attack, a 10 percent increased risk of high blood pressure and blood clots, and a 20 percent increased risk of diabetes.
Overall, obese young men had a nearly 50 percent risk of developing any of these serious health problems by middle age, compared with a 20 percent risk for young men with normal weight, according to a journal news release.

So, we have so much to gain, just by preventing Obesity and those Asians who are not exercising with a BMI( weight in kg divided by height in meters squared, kg/m2) greater than 22-23, by decreasing their weight, they can prevent
DIABETES
HEART DISEASE
STROKE






I will describe here an example of health promotion in a business setting, at a medium size business employing 150 people, in Bogor, Indonesia.
It is important to state that the philosophical aspects are as important as the physical actions. Words without actions mean very little and in the same way actions such as Running or Jogging or Yoga means little if it has not philosophical background. Was it the comedienne Joan Rivers who quipped: The first time I see a Jogger smiling, I will consider it!

HP is an Indonesian, 52 years of age, has always been interested in a good lifestyle which incorporated his philosophy of life, the fundamental of which can be summarized as Help Others and Take care of others without expecting any reward.
He has a business of supplying non ruminant animal feed to farms in the region and he travels a fair bit for his business.  He has six or seven section managers and has collaborators in Malaysia, Cambodia, Thailand, Italy, Sweden, Poland, Spain. He manages his time very well and is usually in good communication with his friends near and far.
He spends time with his family and children and one feels that it is a priority for him. His children accompany him on many of his travels.
These following observations are based on my repeated visits to Sentul/Bogor in Indonesia and meeting him in various places in Asia: Phnom Penh, Bangkok, Kuala Lumpur, Singapore and Europe: Paris and Amsterdam

On the days he is in town, he arrives at the Sentul Lake at around 6 AM. Whoever wish to join him, from his company , is welcome to do so.
On my recent visit to Bogor, I could count up to 10 people, including most of his managers there in the morning.
Up to one hour is spent, on running, walking, jogging and stretching. There is always friendly banter and joking and laughter.
We go back to the office of the business which is situated just one km away and there we may have a fresh Nespresso Coffee (he buys the capsules for this French coffee machine whenever he is in Europe, the last time I was with him when he knew where to buy them in Amsterdam)
Also he might order healthy breakfast for all present from the restaurant attached called Gunung Mas which he owns. One day we had Mee Hoon and it had a less fatty  greasy taste than the one I had in Malacca.
During the hour together at the Office there may be a fifteen minute session of Intense work out, modeled after the Body Works. In my opinion there are Yoga asanas but done in quick successions.
The managers have already spent three hours before they turn their attention to their work.
Do you give the this time off, so that they would be more productive, I asked.
No, I am already satisfied with their work, but giving them this liberty of time to do exercise and spend time socially, I am hoping that they would be happy and that their family would be happy and the villages (suburbs) they live in would be cleaner and healthier. More importantly they could share these stories with their workers.

There is a book published in Singapore, with the title
Zheng He’s Art of Collaboration. The sub title is : Understanding the Legendary Chinese Admiral from a Management Perspective
The author is a vice dean of the School of Business at the National University of Singapore.
He had analyzed the conduct of the Admiral, who had at his disposal the largest fleet ever assembled by man at that time, but he was humble and never intended to conquer any of the kingdoms or sultanates he had visited but came on a mission of peace. It is incredible that even after 600 years his legacy is well remembered for its non colonial stand, its peaceful message and good ambassadorship.
When I was reading the book, I realized that HP somehow manages his business much along the line proposed by Zheng He. I will summarize some salient features of the Art of Collaboration  found in his treatises over the long seven voyages he had for his Ming Emperor Employer..
COMMUNICATION
CAPACITY BUILDING
COORDINATION
CONTINUITY

I used the maxims of the Great General and viewed at the Intentions and Behavior of HP towards his staff and his managers and his friends.
Despite the enormous time he spends with his managers, I have never once heard him discuss business with them. He makes his purpose clear, that with continuing physical exercise and a philosophical life style behind it, every one could achieve the health status he has achieved.
I have told the staff that we would consider HP’s measurements to be the Gold Standard to measures every one else by

BP   98/68
Pulse of 62
He weighs the same as what he did when left the university


I observed that his method of communication was Motivational Interviewing, adjusting his advice to the level needed to make changes. I would explain how he did it with me.
It was my second visit to Sentul/Bogor in 2012 and at that time I had expressed an interest in joining him in walking around the Sentul lake.
Fortunately his shoe size and shorts were suitable to me, so he presented me with a pair of Asics Shoes and a pair of shorts.
He advised me to think that the walking is essential to my health.  You have to have a sensation of addiction to this daily procedure so that wherever in the world you are, you would be finding out a place to do some walking.
For the first three months, don't run or jog, but walk at your pace.
After three months of doing it as often daily as possible, you can increase the pace.
I was ready for the change and was glad that I was not presented with a task of running or jogging like others.  It resonated with the Yogic Philosophy of Patanjali: no undue exhaustion is to be experienced.
I could manage to walk without feeling exhausted only 3 times around the lake. I.e. close to 2 km and it took me more than 30 minutes .
Afterwards he was always congratulatory about my feat and each day encouraged me to do the same.
When I left Sentul that time, getting up to walk in the morning has become routine for me and wherever I was, I was looking forward to doing it. When I am in a hotel or in a strange town, I would also use the facilities in the hotel
By the time I returned for further visits to Sentul, I was walking faster, I have definitely noticed  changes in my body, in my breathing capacity and my well being. In December, just four months after beginning of walking, I was able to walk 10 times around the lake and on a recent visit, my walking time has been halved since I began in August last year.
At all times he has been encouraging me, and making sure that I have shorts, running shoes, socks and tee shirts.
Now I always pack these things when I travel since I have been able to walk in many parts of the world. During winter in the northern hemisphere I was not able to do so .

COMMUNICATION

On each of his emails he would remind me to keep on going and after the predicted three months, it was no longer necessary. If I did not walk one particular day I began missing it.

I have noticed that among his managers, he has chosen them well so that each one shines well in his chosen spot. The manager of the Travel Agency is well travelled and is always available to organize trips for any of us. On my first  visit, he organized a nice sight seeing tour of Jogjakarta and Borobudur, yet on another occasion a trip to Semarang.

He has taken particular efforts at CAPACITY BUILDING  such that the managers do their task without being asked to do it, and he very rarely needs to exhort them to do it.
Because he is the owner of the Business, he can coordinate the wellness activities. He is able to give his managers and those workers who wish to participate up to three hours to participate in wellness activities each day.
CO ORDINATION and lastly

CONTINUITY
He is personally is present each and every day while he is in town at the lakeside to walk, run and jog and more importantly converse, joke and create the right sort of atmosphere for every one to enjoy.

Does this work? The Proof is in the pudding, as they say.
Collectively the people who come to these gatherings regularly have lost over 100 kg. Every one looses weight, first converting their fat into muscle and then loosing weight after a persistence effort of months. So Don't do the exercises and adopt this lifestyle with just the thought of loosing weight, but the objective is to be healthy. People who were overweight or obese have lost the most, and even those with normal body weight have trimmed themselves up

The results of my own measurements.
Pak Joe has a BP of 98/68 with a pulse of 62 which is our gold standard. Among the group only one person has elevated BP but he is loosing weight and I expect the BP to normalize.
No one has Blood sugar levels in the diabetic or pre diabetic range.

This is a gift of Pak Joe which is everlasting, more than any other material gift which would be worn away by time.
In my own case, I am grateful for the enthusiasm for taking care of myself which was instilled on me on the shores of the Lake Sentul in Bogor In Indonesia.

As always, as the great Admiral Zheng He had shown, when you have power and wealth; it is masterful to be humble, shine out what is inside of you, and always think of the welfare of other people rather than any hidden motives or agenda.
I must say, HP from Bogor exemplifies many of the Admiral’s ways, 600 years later!